State Home Visiting Programs - Position Statement

I. ASTHO Supports State Home Visiting Programs

The Association of State and Territorial Health Officials (ASTHO) supports state and territorial health agency leadership and collaboration in state home visiting programs, with the ultimate goal of promoting healthy child development and improving health outcomes for children, women, and families in the United States. Seventy-five percent of Maternal, Infant, and Early Childhood Home Visiting program grants must be used on models of care that are evidence based and cost effective.1 Decades of scientific research has shown home visiting improves child and family outcomes.2

II. ASTHO Recommendations for State and Territorial Health Officials:

Integrate state and local health agencies into a coordinated state home visiting program to promote family health and early childhood development.

Create a home visiting system that addresses the full scope of services based on family and child needs.

Create a comprehensive approach to family needs by integrating and coordinating maternal and child health (MCH) services and social and medical programs such as Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), Title X Family Planning, and services to children with special healthcare needs including early childhood systems activities, trauma-informed systems activities, and early learning agendas.

Assure health and developmental disparities are addressed by incorporating approaches that positively affect the social determinants of health and the development of changes to the environments in which families live, encouraging strong social and emotional supports for families, infants, and young children.

Collaborate with local health departments that implement public health programs and services.

Promote efforts to align longitudinal and integrated early childhood data systems between public health, healthcare, communities, and education.

Collaborate with early childhood education intervention programs to leverage the expertise of education and health professionals in the home.

Work in cooperation with Medicaid and Early Periodic Screening, Diagnosis, and Treatment to leverage funding and resources to support home visiting and mental health services and supports.

Support the identification, sharing, and adoption of promising practices to address the wide variety of needs within states and create the opportunity to demonstrate whether promising practices can be considered model practices.

Support rigorous quality improvement and program evaluation practices to demonstrate program effectiveness, cost savings or neutrality, and seamless provision of services through training, data collection, and evaluation of evidence-based programs to make the case for future investments in home visiting.

Support the current and future home visiting workforce by recruiting, training, and retaining home visitors and supporting leaders during transition and succession planning.

Bolster the home visiting workforce by supporting community health workers and other non-traditional workers as home visitors. Increase access to home visiting services and engagement by families through leveraging existing programs that provide services to pregnant women, children, and families (e.g., WIC); implement tools to better guide referral services (e.g., psychosocial screening tools); and streamline data systems to better identify women and families who could benefit from support services.

Use culturally competent integrators, such as community health workers, to connect families to home visiting services.

Ensure appropriate funding for the sustainability of state home visiting programs.

III. ASTHO Recommendations for the Federal Government:

Continuously support the work of state and territorial health agency leadership to provide seamless services to families by improving collaboration across public health programs, such as MCH, primary care, HIV, injury prevention, oral health, chronic disease, and behavioral health.

Continuously support leadership at the state level as they identify regions of greatest need, streamline services, and promote interagency involvement and cooperation.

Build public awareness, messaging, and education to increase public will and support for home visiting programs

Ensure appropriate funding for the sustainability of state home visiting programs.

IV. Background: Home Visiting

Home visiting programs have been used since the 1880s to deliver medical, public health, and social services to women, children, and families in their homes.3 Home visitors – typically professionals (e.g. nurse) or paraprofessionals (e.g., trained former participant of the program or community leader) – regularly visit homes of young children, usually between birth and five years of age, and their families, for a few months up to several years depending on the program. Professional home visitors assess the health and social needs of the family, offer parenting education, and serve as a link to community services. Home visitors also support families through linkages to care and address social determinants such as housing or employment supports. Paraprofessional home visitors make observations about environmental and safety issues within the household and the family’s ability to access services. They also connect the family to health and social services.4 Home visiting provides families with a support system to counter risks by connecting them to needed community services, such as high quality child care and primary health care. Evidence-based home visiting programs can be an effective method to deliver preventive health and social services to individuals that are at high risk for negative health and developmental outcomes, including child maltreatment and mental health disorders.5

The federally funded Maternal, Infant, and Early Childhood Home Visiting Program provides grants to all 50 states, the District of Columbia, and five jurisdictions (American Samoa, the Commonwealth of the Northern Mariana Islands, Guam, Puerto Rico, and the U.S. Virgin Islands). The states and territories are grantees in all locations except Florida, North Dakota, and Wyoming; in these states nonprofit organizations receive funding to implement home visiting programs. State-based home visiting programs not administered by health agencies are overseen by departments of education, early care and education, mental health, human services, and children's trust funds.6

The Maternal, Infant and Early Childhood Home Visiting Program, Sec. 2951 of the Patient Protection and Affordable Care Act (PPACA),7 created a new section of the Title V Maternal and Child Health Block Grant that gives states grants to deliver services under early childhood home visiting programs. The purpose of the funding is to improve maternal and child health, school readiness, and socioeconomic status and reduce child abuse, neglect, and injuries. Between FY 2010 and FY 2014, $1.5 billion in funding was awarded to the Maternal, Infant, and Early Childhood Home Visiting Program grantees. Most recently more than $106 million was awarded to 43 states and the District of Columbia in August 2014.

PPACA will provide a total of $1.5 billion from 2010-2015 to support state home visiting programs. Priority is given to families identified as high risk based on health, education, and socioeconomic factors.

Approval History

ASTHO Position Statements relate to specific issues that are time sensitive, narrowly defined, or are a further development or interpretation of ASTHO policy. Statements are developed and reviewed by appropriate Policy Committees and approved by the ASTHO Board of Directors. Position statements are not voted on by the full ASTHO membership.

Access Policy Committee Review and Approval: January 2015 Board of Directors review and approval: June 2015

U.S. Congressional Research Service. Home Visitation for Families with Young Children (R40705; July 5, 2009), by Emilie Stoltzfus and Karen E. Lynch. Text in: LexisNexis Congressional Research Digital Collection. Accessed 11-2-2010.

Johnson K. (2009). National Center for Children in Poverty. State-based Home Visiting: Strengthening programs through state leadership.